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MEGUMI IKEDA MITCHELL MS, ATC/LAT
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1760051783
Individual Registrant: MEGUMI IKEDA MITCHELL MS, ATC/LAT
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
21630 STATE HIGHWAY 59 S ROBERTSDALE, AL 36567-6710 US
Tel: 251-947-4154 Fax: 251-947-2666
Tel: 251-947-4154 Fax: 251-947-2666
Contact information for business:
14658 SILVER OAKS LOOP SILVERHILL, AL 36576-3741 US
Tel: 251-600-9448 Fax: --
Tel: 251-600-9448 Fax: --
Registration Information:
NPI: 1760051783
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer | AL | 1339 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
